The Lost Buckyballs

Abstract

A 15 year old female with no past medical history presented to the emergency department after ingesting two Buckyballs she was using to create a mock tongue piercing. She was asymptomatic at presentation. On exam her abdomen was soft, nontender, and nondistended. Abdominal xray was obtained which showed 2 radiopaque objects in the upper abdomen. Repeat xray showed the objects in the lower abdomen. The patient underwent bowel prep and was taken for colonoscopy. The colon and terminal ileum were normal without visualization of the Buckyballs. A repeat abdominal xray showed the objects in the right lower quadrant. A retrograde double balloon enteroscopy was then performed. The enteroscope was advanced 150 cm into the small bowel without visualization of the Buckyballs. Fluoroscopy was then used to confirm the location of the Buckyballs in the right lower quadrant. The enteroscope was reduced under fluoroscopy until the tip of the scope was at the site of the Buckyballs. This placed the enteroscope in the cecum at the appendiceal orifice. The enteroscope was then passed into the appendix. The Buckyballs were found wedged in the tip of the appendix. A 0.035 Boston Scientific DreamwireTM was advanced beyond the balls into the appendix. Attempts were made using a 9mm/12mm Boston Scientific ExtractorTM Pro RX Balloon, a Cook® Memory Soft Wire Basket, a US Endoscopy TalonTM, and an EndoGator®. All of these attempts were unsuccessful at removing the Buckyballs. The patient was taken for laparoscopic appendectomy. The patient recovered without complication.Figure 1Figure 2Figure 3Magnetic foreign body ingestion is most common in the pediatric population (1). The ingestion of two or more magnetic foreign bodies pose the highest risk to patients as the force between two magnets can trap a portion of bowel causing necrosis with fistula formation, perforation, obstruction, volvulus, or peritonitis (2). It is recommended that each magnetic foreign body that is ingested be removed endoscopically if in reach. If not in endoscopic reach it is recommended that the foreign bodies be removed surgically (3). Foreign bodies in the appendix are a well documented occurrence, however, this is the first documented case of a magnetic foreign body in the appendix. Unfortunately the Buckyballs were unable to be removed endoscopically in this patient, but the prompt identification of the Buckyballs by enteroscopy prevented appendiceal necrosis and perforation.